Starting treatment

Oct 2, 2003

Thank you so much doctors for the wonderful advices and the time you spend answering our questions.

I am a South African who is worried about having to start on meds soon. I got my HIV+ test in July at CD4 646 and VL 27,000 but my question is, if one uses immune boosters that are available and the VL increases as of course no meds at the time would you have to start on meds even if your CD4 counts goes up?

I am worried if my next results would have VL greater than 55,000 then the doctor might want me to start on meds and I am not ready for that at this stage. I wish I could wait a little longer. This is also raised because of my worry about availability of proper meds in SA and the costs involved but if I am forced to I will. I am just looking at other options available.Thanks

Response from Dr. Young

Thanks for your question. It is encouraging to me to know that Southern Africans are reading our site.

Most of us here in the US use the viral load test as a secondary criteria for starting medications-- namely the CD4 count really predicts one's immediate risk of having a complication.

As such, with your current counts and high CD4 count, you near-time risk is low. Should you choose to use "immune boosters", I have no concrete data on benefit, but little in the way of harm either.

Assuming that your CD4 count remains about 350, then the need to start medications is not great and hopefully, in the intervening time, your access to appropriate three-drug medication regimens will improve.

I think that you best option is to continue to get periodic laboratory testing to monitor your CD4 count and viral load (we do this about every 3-4 months).

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